European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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P-844
Feasibility and impact of a geriatrician-led liaison service for
older people admitted as an emergency under general surgery.
Salford-POPS – GS
A. Vilches-Moraga 1, J. Fox, A. Gomez-Quintanilla1, D. Copeland1,
J. Mort 1, K. Wardle1, E. Feilding1, Z. Alio1. 1Ageing and Complex Medicine,
Salford Royal NHS Foundation Trust, Manchester, United Kingdom
Objectives: Increasing numbers of older people undergo emergency
hospitalisation and surgery. Comprehensive multidisciplinary has
proven its value in orthopaedics and vascular surgery.
Methods: This prospective study describes patient characteristics
and the impact of a geriatrician-led liaison service for older people
admitted non-electively to general surgery. We provided daily case
finding, multidisciplinary assessment, patient tailored interventions
and discharge planning.
Results: Between 9th September 2014 and 30th November 2015 the
liaison service reviewed 300 patients. Seventy individuals (23.3%)
underwent surgery, 82 (27.3%) a non-surgical procedure, and 148
(49.3%) were managed non-invasively.
Mean age was 82.5 years (70–98), 61.3% ≥80 and 55.7% female. Most
individuals lived in their own home (90.7%), were independent in basic
(77.5%) and instrumental (52.5%) activities of daily living. 46.3%
mobilised with no walking aids or using a stick.
Multimorbidity (5.2 chronic conditions on average, and 96% ≥2) and
polypharmacy (8.6 medications on average and 41.4% taking ≥10 at
presentation) were the norm. Liver and biliary conditions (23%) and
cancer (19.3%) were the most common diagnoses. Median and mean
length of stay were 8 days and 13 days (1 –207).
30-day readmission rate was 14.3% (40/279). Mortality rates in
hospital, 30-days after hospital admission, 30-days after surgery and
30-days post-discharge were 7% (21/300), 8.7% (26/300), 8.6% (6/70)
and 5.4% (15/279) respectively.
Conclusions: Older individuals admitted non-electively under general
surgery often have cognitive or functional impairment and complex
social issues. A geriatrician-led liaison service facilitates recognition of
complications, enhances management of multimorbidity and poly-
pharmacy and drives discharge planning.
P-845
Prognostic factors in non-cardiac surgery in elders
J.C. Viveros García, J.L. Torres Gutiérrez, C.A. Moreno. Hospital Regional
del ISSSTE, León, Guanajuato, México
Background: Demographic transition have increased the number of
elders who develop surgical need. There is few evidence among
prognostic factors in the perioperative period in elders. Objetive: Find
factors associated to complicagtions in the posoperative period among
elder patients who underwent non-cardiac surgery.
Methods: Observational, descriptive, prospective trial which included
patients 65 years and older who underwent non cardiac surgery.
Data were taken from the patient ’s file. Inclusión criteria: patients 65
years or older who underwent non cardiac surgery. Exclusion criteria:
ambulatory procedures and discharge before 24 hrs. We measured the
baseline characteristics of the patients: age, gender, tipe of surgery,
acute renal failure, vasoactive medications, current medications,
laboratory results and geriatric syndromes. The main outcome was
to identify factors associated to morbimortality in the posoperative
period. Stadystical Analysis: Software SPSS. Cuantitative variables
were analized by T Student, cualitative variables were analized by chi
square test.
Results: Between july 2013 and june 2014 we included 100 patients
65 years and older who undergent non cardiac surgery. The mean
age was 78.5 years old. 47.5% were scheduled procedures. The mean
length of stay was 11.3 days, the patients of the neurosurgery
department stayed longer. Acute kidney injury, depression, falls, sore
ulcers and incontinency were associated with poor prognosis.
The main complications were delirium, and pneumonia.
Conclusions: The elderly patient often needs surgery, scheduled or
urgent. Most issues related to a poor prognosis may be corrected or
prevented. Age is not related to a poor prognosis in elderly surgery
patients.
P-846
Hemodynamic, geriatric and quality of life assessment after aortic
valve replacement in an old population hospitalized in Liege
University Hospital Belgium
S. Allepaerts1, S. Wislez 1, S. Bruls 2, M. Radermecker2, P. Lancellotti3,
J. Petermans1. 1Geriatric Department, Liège University Hospital,
2Cardiovascular Surgery Department, Liège University Hospital,
3Cardiology Department, Liège University Hospital, Liège, Belgium
Introduction: Surgical aortic valve replacement (SAVR) remains the
standard treatment of symptomatic aortic stenosis, though transcath-
eter AVR is indicated in non suitable surgical candidates. Risk of
morbidity and mortality are satisfactory in aging subjects. Few data are
available concerning the quality of life in the long-term after AVR.
Methods: We performed a retrospective study on 108 patients (age:
79 ± 5 years) who underwent surgical AVR or combined with coronary
artery bypass between January 2001 and December 2006. In 2012
(6.6 ± 1.4 years after surgery), an echocardiography, a comprehensive
geriatric assessment (CGA), an evaluation of quality of life were
obtained.
Results: 30-day mortality was 9.2%. Survival at 1, 3, 5-year was 83%,
69.6%, 55.1%. Renal (p = 0.011) and respiratory (p = 0.005) failure,
stroke (p = 0.031) and delirium (p = 0.002) increased the risk of early
death. Pre and post surgery hemodynamic values showed a drop in
mean aortic pressure gradients (p < 0.0001), an increase of effective
orifice area (p < 0,0001). 67% of patient still living at home. The average
Mini Mental State was 25.6 ± 4.2, 20% had a risk of malnutrition, and
10% had a suspicion of depression. 40% of the patients had fallen
within 6 months. Quality of life was worse for physical activity and
perceived health, better for limitations due to psychic state, physical
pain, vitality and relationship, and similar on the limitations due to
physical state and mental health.
Conclusion: Surgical AVR in elderly patients with aortic stenosis can
be performed with an acceptable mortality. Both long-term functional
recovery and quality of life appear reasonable.
Area: Psychiatric symptoms and illnesses
P-847
Psychotropic medication reconciliation: considering
orthogeriatric unit admission a chance of therapeutic switch
A. González Ramírez, R. Pérez López, M.M. Luis, C. Pablos Hernández,
J.M. Julián Enríquez, J.F. Blanco Blanco. Universitary Hospital of
Salamanca
Introduction: The geriatric patient is particularly susceptible to
serious side effects (falls, delirium, daily somnolence) of psychotropics
(benzodiazepines, hypnotics, neuroleptics). Therefore, its withdrawal
could possibly improve their quality of life. When considering
psychotropic withdrawal, trazodone presents an ubiquitary action
and a safe profile.
Objectives: To implement a psychotropic prescription withdrawal by
alternative prescription of trazodone in an Orthogeriatric Unit during
hip fracture perioperative period.
Material and methods: Retrospective observational descriptive study.
Population: 65-year-old patients or older with hip fracture consecu-
tively admitted in an Orthogeriatric Unit (June 2015 – May 2016).
Inclusion criteria: on >3 month psychotropic treatment, eventual
psychotropic side effects. Source: Medora® , Farmatools® , anamnesis
and global geriatric assessment file. Database and statistical analysis:
FilemakerPro®.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S252